Provider Demographics
NPI:1376777359
Name:LSREF GOLDEN OPS 26 (AZ), LLC
Entity Type:Organization
Organization Name:LSREF GOLDEN OPS 26 (AZ), LLC
Other - Org Name:EMERALD SPRINGS RETIREMENT AND ASSISTED LIVING COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-436-7662
Mailing Address - Street 1:500 STEVENS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1475 S 46TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4010
Practice Address - Country:US
Practice Address - Phone:928-329-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC-6937310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility